Background: Cardiovascular stress due to reflex sympathetic over activity is a great concern during laryngoscopy and endotracheal intubation. Aims and Objectives: To compare the efficacy and safety of esmolol and verapamil for attenuation of hemodynamic effects (heart rate, systolic blood pressure, diastolic blood pressure and mean arterial pressure) due to laryngoscopy and endotracheal intubation in elective surgical cases. Materials and Methods: A prospective, randomized, double blinded, controlled study was conducted on 60 patients divided equally into 30 each receiving esmolol (2 mg/kg body weight) and verapamil (0.1 mg/kg body weight) respectively. Heart rate, systolic and diastolic blood pressure and mean arterial pressure were recordedat pre-operative stage, after administration of the study drugs, immediately after intubation and at 1 ,3 ,5 minutes after intubation. Data collected were statistically analyzed. Results: The mean systolic blood pressure was lower in the esmolol group at all times of estimation compared with the verapamil group and the difference was at the time of intubation (p value <0.001).The mean diastolic blood pressure was lower in the esmolol group at all times of estimation compared to the verapamil group which was not statistically significant at any time of estimation. The mean arterial pressure was significantly lower at the time of immediately after intubation (p<0.001) in esmolol as compared to verapamil group. Adverse effects in both the study groups were insignificant. Conclusion: Esmololand Verapamil can effectively attenuate the cardiovascular stress to laryngoscopy and endotracheal intubation with the former appears to be a better alternative from efficacy and safety perspectives.

Background: Spinal anaesthesia is the commonly used technique for lower abdominal surgeries. Adjuvants to bupivacaine have been used to provide good quality of perioperative and postoperative analgesia. The aim of the study was to evaluate the effects of subarachnoid administration of bupivacaine with clonidine, magnesium, dexmedetomidine and saline group.Methods: The prospective, comparative single blind study included 120 patients in American society of anaesthesiologist (ASA) grade I and II, scheduled for lower abdominal surgeries were allocated in four groups. Each group included 15 mg bupivacaine with various adjuvants (30 µg clonidine, 50 mg magnesium sulphate and 3µg dexmedetomidine) were compared with saline group (group S).Results: Time of onset was earlier in groups D and C but delayed in group M. The total power regains (B0) in group D (250.8±18.87), group M (235.23±24.66) and group C (242.70±25.98) were significantly delayed (p<0.05) as compare with group S (180.07±18.53). Demand of analgesia was significantly earlier in group S as compared with groups C, M and D. Similarly, the time of two segment regression was significantly earlier in group S as compared with groups C, M and D (p<0.001). Patients were hemodynamically stable in groups D, C and M as compared to Group S.Conclusions: Dexmedetomidine and clonidine were equally effective and better as compared to magnesium as an adjunct to intrathecal bupivacaine.

Background: Off-pump coronary artery bypass grafting (OPCABG) is a common and acceptable surgery. Aims and Objectives: The study was conducted to compare central venous oxygen saturation (ScvO2) and regional cerebral oxygen saturation (rSO2) to see which of the two is better predictor for the prognosis of patients undergoing OPCABG. Heart rate (HR), invasive blood pressures, and partial pressure of oxygen (pO2) have also been recorded to see if they are independent predictors of prognosis in OPCABG patients. Materials and Methods: A total of 56 patients undergoing OPCABG were included in the study. Baseline values and intraoperative values of ScvO2, rSO2, HR, systolic blood pressure (SBP), diastolic blood pressure (DBP), mean arterial pressure (MAP), pO2 at different time periods were recorded. Post-operatively the patient was shifted to intensivecare unit (ICU) in intubated condition, and time to extubation since shifting to ICU was noted. Results: The ScvO2 values after sternal closure (correlation coefficient r=−0.4821, P=0.0002), and on shifting to ICU (correlation coefficient r=−0.4575, P=0.0004) showed good correlation with time to extubation. Similarly, the rSO2 values after sternal closure (correlation coefficient r=−0.5198, P<0.0001) and on shifting to ICU (correlation coefficient r=−0.5498, P<0.0001) showed good correlation with time to extubation. HR SBP, DBP, MAP, pO2 individually did not show any correlation with time to extubation (P>0.05). Conclusion: ScvO2 and rSO2 both have strong correlation with time to extubation and are capable of predicting prognosis in OPCABG patients.